Electrosurgery in the Gastrointestinal Suite: Knowledge Is Power.

Electrosurgery allows both cutting and coagulation of tissue and is an essential tool for therapeutic endoscopy. Electrosurgery is also the most commonly used and misunderstood technology by all surgical and medical disciplines. In other words, everyone uses it, but few understand it! The aims of this article are to (1) present a useful review of the fundamentals of electrosurgery technology; (2) relate the fundamentals to commonly performed flexible endoscopy procedures; and (3) provide a review of the safe application of grounding pads, careful management of accessories, and special patient safety considerations.

Electrosurgery in gastrointestinal endoscopy: principles to practice.

An electrosurgery generator unit is a critical piece of equipment in any therapeutic endoscopy setting. Electrosurgery generators produce high-frequency alternating electric current and differ from electrocautery units in that both cutting and coagulation effects can be achieved. This ability to cut and coagulate at the same time makes electrosurgery an ideal therapeutic tool for gastrointestinal endoscopy. Although education and familiarity with these devices are accepted as the primary avenue to the safest and most effective clinical outcomes, concise information linking the basic properties of electrosurgery directly to clinical practice is not widespread. The following are the aims of this article: (i) to relate the fundamental electrosurgical principles to commonly performed procedures such as snare polypectomy, hot biopsy, sphincterotomy, bipolar hemostasis, and argon plasma coagulation, and (ii) to provide practical suggestions for the use of these devices on the basis of an understanding of electrosurgical principles and the available clinical data.

Electrosurgery in the gastroenterology suite: principles, practice, and safety.

An electrosurgery generator is a critical piece of equipment in any therapeutic endoscopy setting. Electrosurgery uses rapidly alternating current, provided by the electrosurgery generator, for both therapeutic cutting and coagulation of tissue. Basic variables important to electricity in general are also important to electrosurgery: current, voltage, circuit, and impedance (resistance). Monopolar and bipolar accessories (electrodes) are used in the endoscopy suite and these terms refer to the way in which the electric circuit is completed by the flowing current. Impedance resists current flow and changes with tissue type and degree of therapeutic coagulation. Waveforms are the high-frequency output selected by the operator when using an electrosurgery generator. Waveforms may be continuous or interrupted (modulated) and differ in voltage and degree of modulation. Certain waveforms are typically chosen for particular applications or accessories, such as polypectomy with a snare, because of predictable tissue-effect attributes of that waveform. Safe application of grounding pads, careful management of active accessories, and good care of electrosurgical equipment are crucial to patient and operator safety.